KARACHI: A study recently published in an international journal has found high prevalence of suicidal thoughts among young students, especially girls, in Karachi, highlighting the need to establish mental health support services for students at the institutional level.

Titled ‘On the pathway to suicide: suicidal ideation in young people in Karachi, Pakistan’, the study is published in the Youth Voice Journal.

It was conducted by Dr Murad Moosa Khan, Dr Ehsanullah Syed, Dr Nargis Asad, Dr Mohammad Zaman and Dr Shahina Pirani at the Aga Khan University (AKU).

Study participants were 123 students of Grade 9 to Grade 13 at one of the co-educational high schools of upper-middle class in Karachi. They were assessed to estimate the prevalence of suicide ideation and to examine the relationship between socio-demographic factors and suicidal ideation among high school students.

The school offered various facilities to students, including science and computer laboratories, a library hall, career counseling and medical facilities.

The study included 61.8pc male and 38.2pc female students between 14 and 18 years, a majority of them were in Grade 9 and Grade 12.

A specific questionnaire was used to record information after taking the school administration, parents and students into confidence.

Results showed that 58.54 per cent of the total sample had suicidal thoughts. Female gender and past visit to mental health professional were significantly associated with the desire to make a suicide attempt.

More than half of the study participants lived in nuclear family. Majority had 5-9 household members. With regard to participant’s father qualification, most of them were at graduate or post-graduate level and they were either professionals or businessmen.

Only four parents had ever visited a mental health professional. The obtained data, the study says, doesn’t suggest that if there were any unidentified cases of mental illnesses amongst them.

High passive suicidal ideation

An alarming finding of the study was high prevalence of passive suicidal ideation (37.40pc) as compared to active suicidal ideation (21.14pc).

A majority of the participants (84.5pc), however, considered suicide or suicide ideation as ‘sinful’.

An active suicide is explained as when a person with suicidal thoughts has formulated a plan to kill one’s self. Passive suicide ideation is when one person has thoughts of suicide or self-harm, but no concrete plan to harm.

Past literature indicates that one-third of individuals with a past suicide attempt had passive suicidal ideation, but no active ideation or plan, suggesting the vulnerability of study participants for risk of suicide, the study says.

“The study findings provide areas for active intervention. There is a need for psychological support services in educational institutions in Pakistan which students can access easily assuring confidentially and without fearing any adverse impact on academic assessments.

“This would not only reduce the stigma of mental health but also serve as an important preventive step against suicidal behaviours. Mobilizing informative campaigns would guide the academic community about the symptoms associated with common mental disorders. Besides, screening of suicidal ideation and educating school authorities on a referral pathway can be helpful strategies,” the study says.

At the end of the survey, all participating students were handed a referral slip for mental health services at AKU, for a free-of-charge consultation.

The study also highlights barriers to and support for people having suicidal thoughts and says that since any act of self-harm is considered illegal in Pakistan, help seeking behaviour is also limited. If the person survives with deliberate self harm attempt, his or her family prefers to hide the act rather than seek mental help.

“This (also) limits researchers from exploring suicidal ideation in the population. However, it is critical to identify young people at greatest risk for suicide in the hope of intervening before a tragic consequence,” it says.

The study suggests creating public awareness through the media on risky behaviours, encouraging youth to talk about their stressors.

“Close student-teacher interaction and realistic expectations at the parental and school level can also serve to mitigate young peoples’ stress by acting as protective factors,” it says.

Suicide highly stigmatized

The study cites WHO data according to which suicide is the second leading cause of death in young people aged 15-29 years globally. Low and middle-income countries (LMICs) contribute 78 per cent of all suicidal deaths. In year 2012, 804,000 suicide deaths occurred worldwide.

“In Pakistan, suicide is considered a criminal act, religiously forbidden and highly stigmatized. Due to this reason and other socio-cultural factors, suicide cases are underreported. However, suicidal behaviors occur regularly across Pakistan, with an estimated 13,377 suicidal deaths with the rate of 7.5/100,000 (WHO, 2014),” it says.

Suicidal behaviours, according to the study, are global public health issues and suicidal ideation is the first step on the suicide ‘pathway’ and an important area of potential intervention for primary prevention of both deliberate self-harm and suicide.

There is evidence to suggest that 50 per cent of planned suicidal attempts occur within one year of suicidal ideation. Literature documents variable figures on prevalence of suicidal behaviour among young people from high income and low and middle income countries.

For instance, in high income countries such as the United States, it is estimated in 2012 that up to 16 per cent of high school students attempted suicide and 13 per cent of students had a plan for their suicide attempt over a year.

A recent study from Iran found that prevalence of suicidal ideation was 4.1 per cent among high school students aged 15-17 years. Females had been found four times more likely to report suicidal behaviours compared with males in a 2009 study.

The WHO estimated a suicide rate of 9.1 per 100,000 among 15-29-year of age in Pakistan in 2014.

Published in Dawn, September 16th, 2018

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